Question
Hi around one year ago I landed heavily on my ribs whilst moontain biking. Week or so later I experienced what I can only describe as a panic attack in the form of a feeling of deep agitation below my sternum which lasted a bout 1 hour. I did not have a racing pulse. Subsequently I had around four or five more 'attacks' more recently I nolonger experience these attacks but have aches between my shoulder blades and lower spine the lower ribs are also tender to touch around the sternum although these symptoms are intermittent. When symptoms arise I generally feel poorly and better again when they go. The symptoms are increasingly persistant and toubling.

Answer
Dear Frank,


I have seen this actual presentation about 4-5 times a year in my clinic and the presentation is almost always the same. Primary complaint is chest and rib pain that can be constant or intermittent and feel like a heart attack (pain and pressure behind sternum), but with no radiation to the shoulder, neck, jaw or arms, back pain, pain upon deep breathing, and soreness to the touch...sound familiar?

You need to go to a chiropractic physician, this is a musculoskeletal problem of the anterior rib cage where the ribs meet the sternum as well as posterior rib cage with vertebral dysfunction.  This is actually more common.  This is often termed costochondritis or Tietse syndrome.  Basically the joint capsule that surrounds the rib/sternum is inflamed and is the cause of the chest pain...and yes is happens in the back as well because the rib attaches at both sites...both sites will need to be addressed as well.  Chiropractic physicians are well aware that this is basically a rib subluxation, and these types of articular dysfunction can be quite painful (due to joint inflammation), and frequently become recurrent when not addressed.

The best thing you can do right now is put ice directly over the chest for 20 minutes and repeat this every two hours.  This helps to reduce local inflammation and diminish pain.  Find a good local chiropractic physician to examine the skeletal system and adjust the rib articulations at the sternum and the back.  Note:  you will be very tender on the sternum where the rib dysfunction is found and you may actually be able to feel a small tender nodule..this is swelling and scar tissue at the site of involvement and can contain some minor muscle spasm as well.

Chiropractic care to include manual adjustments to the rib/vertebral joint will normalize the the structure of the joint, but you will likely need multiple treatments because of the length of time this has been problematic.  The reason for this is the surrounding joint capsule...as the rib moves in relation to the vertebral surface it connects with, the capsule becomes stretched and can sustain minor/minimal stretching and tearing.  Over time these small trauma build up and create laxity of the joint capsule.  This is the reason that the problem tends to recur.  

As the chiropractic physician adjusts this area, the body will have to heal the small dysfunctional joint capsule laxity over time.  To help this healing process, a joint support nutritional formula such as glucosamine/chondroitin and MSM will help. (Probably won't need this more than 3 months)  Again, remember that this may take 6-8 visits, and the chiropractor may include electrical stimulation or ultrasound depending on how the joint space if functioning at the time of the examination.  Moreover, a progressive chiropractic physician will incorporate soft tissue mobilization techniques and may possibly use a taping technique to stabilize the area and further reduce inflammation (Kinesiotaping or Leukotape).  A functional evaluation is the only true way to find out what is going on...get it scheduled.

Hope this helps Frank.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net